Nurses on the Perinatal Nursing List repeatedly ask questions about epidural anesthesia/analgesia in labor. In fact, over the last year, not 1 month went by without several epidural questions. This is clearly a hot topic!! I have summarized and paraphrased only a few of those discussions for you into a list of frequently asked questions (FAQs), along with some list member responses.
Epidural FAQs
Where Can You Find the Practice Standards for Nursing Care With Epidural Anesthesia?
Repeatedly, members refer to the Association of Women's Health, Obstetric and Neonatal Nurses' (AWHONN) Evidence-Based Clinical Practice Guideline (EBG): Nursing Care of the Woman Receiving Regional Analgesia/Anesthesia in Labor (AWHONN, 2001). This EBG, with detailed practice guidelines, rationales, references, and evidence ratings, is an essential resource for nurses.
Are Nurses Managing Epidural Medication Dosing?
Nurses continually cite another essential nursing resource, the AWHONN Position Statement "Role of the Registered Nurse in the Management of the Patient Receiving Analgesia/Anesthesia by Catheter Techniques" (http://www.awhonn.org/) to reiterate that the practice of insertion, injection, re-bolus, and initiating a continuous infusion is not a nursing responsibility. Nurses report how they use this statement to defend scope of practice in their settings.
Does the Anesthesia Provider Remain in the Facility?
When considering practice differences, members want to take into account the availability of the anesthesia provider. While most members affirm that the anesthesia provider remains in the facility throughout the labor, many are in situations where the provider does not.
How Much Intravenous (IV) Preload Does the Mother Receive?
Most members report an ordered pre-anesthesia IV fluid bolus of 1000 mL; however, nurses elaborated on the importance of monitoring the mother's fluid balance with intake and output measurements.
What is the Frequency of Vital Signs (VS) Assessment After Epidural Placement?
The AWHONN Guidelines explain that there is insufficient evidence to support a definitive recommendation for the frequency of vital signs assessment but suggest evaluation of blood pressure (BP) and fetal heart rate (FHR) every 5 minutes during the first 15 minutes following initial or rebolus doses (AWHONN, 2001). Consequently, many members report assessing maternal BP, pulse, and respiratory rate every 5 minutes for the first 15 minutes along with continuous FHR monitoring.
Are Mothers With an Epidural Monitored With Pulse Oximetry?
Some members report that pulse oximetry (maternal oxygen saturation monitoring) is used during the initial catheter dosing; however, oxygen saturation measurement is not a recommendation in the nursing guideline (AWHONN, 2001).
Do Nurses Administer IV Ephedrine for Maternal Hypotension?
Nursing care with epidural anesthesia includes interventions for managing hypotension and may include IV ephedrine as ordered (AWHONN, 2001). Several members state that one dose of ephedrine is an approved IV push medication for nurses in their facility, following a standing order or an individual verbal order from the physician. In some cases the physician is at the bedside while the nurse administers ephedrine, and in other cases the nurse notifies the anesthesia provider after administration. Nurses report that hypotension is defined as a systolic BP less than 100 or 90 mm Hg or a 20% systolic decrease from baseline values. Sometimes the mother is placed on a cardiac monitor during induction. Prophylactic IV administration of ephedrine following the test dose can reduce the frequency of adverse FHR changes (Kreiser Katorza, Seidman, Etchin, & Schiff, 2004).
Who Removes the Epidural Catheter?
Very few nurses report that the anesthesia provider removes the catheter. Most state that there is a policy and competence established for nurses to remove the catheter.
Despite this never-ending discussion about epidurals, we must remember to maintain our focus on the mother; we are caring for a mother and not a procedure. Join the Perinatal Nursing List to discuss care of the laboring woman receiving epidural anesthesia/analgesia (http://nursing.buffalo.edu/mccartny/perintal.htm).
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